# Alignment, Mining and Fusion: Representation Alignment with Hard Negative Mining and Selective Knowledge Fusion for Medical Visual Question Answering

arXiv: https://arxiv.org/abs/2510.08791 · HTML: https://mlsanity.com/paper/2510.08791/

## Key facts

- Cited by 1 papers in the map (data through 14 Oct 2026).
- Builds on 44 of its 61 references that are in the map.
- First posted on arXiv 9 Oct 2025.

## Builds on (most cited first, 30 of 44)

- [Learning Transferable Visual Models From Natural Language Supervision](https://mlsanity.com/paper/2103.00020/) (2021)
- [A Simple Framework for Contrastive Learning of Visual Representations](https://mlsanity.com/paper/2002.05709/) (2020)
- [Distilling the Knowledge in a Neural Network](https://mlsanity.com/paper/1503.02531/) (2015)
- [Graph Attention Networks](https://mlsanity.com/paper/1710.10903/) (2017)
- [Representation Learning with Contrastive Predictive Coding](https://mlsanity.com/paper/1807.03748/) (2018)
- [Convex optimization](https://mlsanity.com/paper/2106.01946/) (2021)
- [Align before Fuse: Vision and Language Representation Learning with Momentum Distillation](https://mlsanity.com/paper/2107.07651/) (2021)
- [ViLT: Vision-and-Language Transformer Without Convolution or Region Supervision](https://mlsanity.com/paper/2102.03334/) (2021)
- [Unified Language Model Pre-training for Natural Language Understanding and Generation](https://mlsanity.com/paper/1905.03197/) (2019)
- [Contrastive Learning of Medical Visual Representations from Paired Images and Text](https://mlsanity.com/paper/2010.00747/) (2020)
- [MIMIC-CXR-JPG, a large publicly available database of labeled chest radiographs](https://mlsanity.com/paper/1901.07042/) (2019)
- [MedCLIP: Contrastive Learning from Unpaired Medical Images and Text](https://mlsanity.com/paper/2210.10163/) (2022)
- [BiomedCLIP: a multimodal biomedical foundation model pretrained from fifteen million scientific image-text pairs](https://mlsanity.com/paper/2303.00915/) (2023)
- [ClinicalBERT: Modeling Clinical Notes and Predicting Hospital Readmission](https://mlsanity.com/paper/1904.05342/) (2019)
- [SLAKE: A Semantically-Labeled Knowledge-Enhanced Dataset for Medical Visual Question Answering](https://mlsanity.com/paper/2102.09542/) (2021)
- [Unifying Vision-and-Language Tasks via Text Generation](https://mlsanity.com/paper/2102.02779/) (2021)
- [KEPLER: A Unified Model for Knowledge Embedding and Pre-trained Language Representation](https://mlsanity.com/paper/1911.06136/) (2019)
- [Knowledge Enhanced Contextual Word Representations](https://mlsanity.com/paper/1909.04164/) (2019)
- [PMC-CLIP: Contrastive Language-Image Pre-training using Biomedical Documents](https://mlsanity.com/paper/2303.07240/) (2023)
- [Multi-Granularity Cross-modal Alignment for Generalized Medical Visual Representation Learning](https://mlsanity.com/paper/2210.06044/) (2022)
- [Interactive and Explainable Region-guided Radiology Report Generation](https://mlsanity.com/paper/2304.08295/) (2023)
- [Multi-Modal Masked Autoencoders for Medical Vision-and-Language Pre-Training](https://mlsanity.com/paper/2209.07098/) (2022)
- [Medical Visual Question Answering: A Survey](https://mlsanity.com/paper/2111.10056/) (2021)
- [Filtering, Distillation, and Hard Negatives for Vision-Language Pre-Training](https://mlsanity.com/paper/2301.02280/) (2023)
- [Joint Learning of Localized Representations from Medical Images and Reports](https://mlsanity.com/paper/2112.02889/) (2021)
- [Advancing Radiograph Representation Learning with Masked Record Modeling](https://mlsanity.com/paper/2301.13155/) (2023)
- [Overcoming Data Limitation in Medical Visual Question Answering](https://mlsanity.com/paper/1909.11867/) (2019)
- [MedICaT: A Dataset of Medical Images, Captions, and Textual References](https://mlsanity.com/paper/2010.06000/) (2020)
- [MMBERT: Multimodal BERT Pretraining for Improved Medical VQA](https://mlsanity.com/paper/2104.01394/) (2021)
- [Robust Cross-Modal Representation Learning with Progressive Self-Distillation](https://mlsanity.com/paper/2204.04588/) (2022)

## Built on by (most cited first, 1 of 1)

- [BIRD: Distilling Decision Boundaries into Rationales for MLLM Adaptation](https://mlsanity.com/paper/2609.33713/) (2026)

## Abstract (arXiv)

Medical Visual Question Answering (Med-VQA) is a challenging task that requires a deep understanding of both medical images and textual questions. Although recent works leveraging Medical Vision-Language Pre-training (Med-VLP) have shown strong performance on the Med-VQA task, there is still no unified solution for modality alignment, and the issue of hard negatives remains under-explored. Additionally, commonly used knowledge fusion techniques for Med-VQA may introduce irrelevant information. In this work, we propose a framework to address these challenges through three key contributions: (1) a unified solution for heterogeneous modality alignments across multiple levels, modalities, views, and stages, leveraging methods like contrastive learning and optimal transport theory; (2) a hard negative mining method that employs soft labels for multi-modality alignments and enforces the hard negative pair discrimination; and (3) a Gated Cross-Attention Module for Med-VQA that integrates the answer vocabulary as prior knowledge and selects relevant information from it. Our framework outperforms the previous state-of-the-art on widely used Med-VQA datasets like RAD-VQA, SLAKE, PathVQA and VQA-2019.